Candida arteritis in kidney transplant recipients: case report and review of the literature.

Multi-organ procurement is a risk factor for contamination of preservation fluid with intestinal flora including fungi (e.g., Candida). Transmission of fungal species to the graft vessel can cause mycotic arteritis. This is a very rare but life-threatening complication of renal transplantation. We present 2 cases of renal transplant recipients from the same multi-organ donor. Both recipients suffered from severe hemorrhages from renal graft anastomosis and renal artery pseudoaneurysm due to Candida albicans arteritis (CAA). The culture of the preservation fluid revealed growth of Escherichia coli, but neither preservation fluid nor multiple routine blood cultures performed before hemorrhagic complications revealed fungal growth (media non-selective for fungal growth were applied). The first recipient suffered from sudden severe hemorrhage in the area of graft anastomosis on day 10 post surgery (without any preceding clinical or radiological symptoms). This led to urgent surgery and graftectomy, which was complicated by cardio-respiratory arrest with resuscitation in the operating room; despite resuscitation, irreversible brain damage, and subsequent death occurred in the intensive care unit (ICU) 2 weeks later (on day 24 after transplantation). The second patient underwent urgent vascular surgery on day 22 (after transplantation), because of hemorrhage from a pseudoaneurysm of the graft artery. She required repeated vascular operations, extended antimicrobial and antifungal therapy, and ICU monitoring and, despite these interventions, she died on day 80 after transplantation as a result of Pseudomonas aeruginosa sepsis. Arteritis of the renal artery in both patients was caused by C. albicans. This was confirmed by histopathology: infiltration of renal artery with budding yeast forming pseudohyphae (Case 1), and the presence of C. albicans in the culture of the renal artery and surrounding tissue (Case 2). We conclude that organ preservation solution should be cultured with use of media selective for fungal growth. As soon as the positive culture is detected, appropriate measures protecting patients against CAA should be undertaken.

Pancreatic remnant fate.

There is eternal discussion on the best surgical method of pancreatoduodenectomy and reconstruction method. Several different methods of pancreatic stump anastomosis exist. The most popular argument taken into account in the discussion is the frequency of early postoperative complications. Relatively fewer papers analyse the late functional outcome of pancreatic surgery and the method of anastomosis employed. Authors presented short series of 12 patients after pancreatic surgery with analysis of pancreatic remnant morphology and function. Pancreatic remnant volume, pancreatic duct distension and stool elastase-1 test were analysed. There was no correlation of pancreatic exo- or endocrine insufficiency with the volume of pancreatic remnant or the kind of surgery or anastomosis performed.

Postoperative PTH measurement as a predictor of hypocalcaemia after thyroidectomy.

BACKGROUND: Hypocalcaemia after thyroidectomy is the most common postoperative complication, with a reported incidence from 0.5% to even 50% of the operated patients. Hypoparathyroidism could be a result of careless or inadequate preparation during the surgical procedure. There is a variety of proposed options for the prediction of the incidence of hypocalcaemia. The most effective of them are the peri-operative and intra-operative measurements of the parathyroid hormone (PTH) level. METHODS: A prospective study was performed on 100 patients who underwent total thyroidectomy from January 2007 to June 2008. The total calcium level and intact human PTH (iPTH) levels were measured 24 hours before as well as 1 hour and 24 hours after the surgery. THE AIM: The goal of the study was to assess the potential correlation between the iPTH levels after the operation and the development of hypocalcaemia. The possible prediction value of postoperative iPTH levels was to be assessed. RESULTS: We have presented a significant correlation between early iPTH measurement and the risk of hypocalcaemia. Moreover, a significant correlation between the iPTH level one hour after operation with the calcium level 24 hours after the operation was demonstrated. CONCLUSION: Early postoperative assessment of iPTH levels can be used to identify the group of patients at risk of hypocalcaemia after thyroidectomy. Pre-emptive calcium supplementation can lead to the avoidance of complications causing prolonged hospital stay and most importantly to prevent severe hypocalcaemia.

Decrease in serum protein carbonyl groups concentration and maintained hyperhomocysteinemia in patients undergoing bariatric surgery.

BACKGROUND: Human obesity is associated with oxidative stress but the factors contributing to the increase of reactive oxygen species (ROS) production remain unknown. We evaluated the association between serum homocysteine concentration, which may increase ROS production, and serum protein carbonyl groups concentration before and after bariatric surgery. METHODS: Serum protein carbonyl groups and serum homocysteine concentrations, as well as obesity markers, were compared in 18 obese patients before and 6 months after bariatric surgery. Ten healthy individuals with normal body mass index (BMI) served as controls. RESULTS: Before bariatric surgery, obese patients displayed approximately 50% higher serum protein carbonyl groups concentration than control subjects. After surgery, serum protein carbonyl groups concentration decreased and matched values observed in controls. Serum homocysteine concentration was also elevated in obese patients, but in contrast to protein carbonyl groups, did not change after surgery. The body weight, BMI, HOMA-IR, serum leptin, triacylglycerols, LDL/HLD cholesterol ratio, insulin, and glucose concentrations were higher in obese patients as compared to controls, and decreased after bariatric surgery. CONCLUSIONS: This study demonstrates that bariatric surgery has protective effect on oxidative protein damage and improves several laboratory parameters including serum lipid concentration and insulin resistance. However, bariatric surgery does not cause a decrease in serum homocysteine concentration, a risk factor for the development of cardiovascular diseases. Collectively, the results presented in this paper suggest that serum homocysteine concentration is not directly associated with oxidative stress in obese patients after bariatric surgery.

Quality of life after surgical treatment of pancreatic cancer.

BACKGROUND: This study was designed to assess postoperative changes in the quality of life (QoL) of patients after surgical treatment for pancreatic cancer. MATERIAL AND METHODS: QoL was analyzed in a prospective single-centre study that included 54 patients with pancreatic cancer. Patients with potentially resectable tumours underwent pancreaticoduodenectomy (PD) (n = 26), a double-bypass procedure (DBP) (n = 17) or laparotomy (L) (n = 11). They were asked to complete a questionnaire before and at 1, 2, 3 and 6 months after surgery. QoL was assessed using the EORTC QLQ-C30 and EORTC QLQ-PAN26 questionnaires (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and PAN26). RESULTS: The patients did not demonstrate significant differences in the assessment of their global health status. Although, after resection, patients gave a positive assessment of most parameters in question, after DBP they reported some aggravation of most of the symptoms. The majority of patients did not have aggravated symptoms after laparotomy. CONCLUSIONS: The study has shown the value of conducting both curative and palliative resection for QoL. Bypass procedures should be performed in cases of non-resectable pancreatic cancer with accompanying jaundice and/or gastric outlet obstruction in patients with a life expectancy of at least 6 months.

New-onset Diabetes Mellitus After Kidney Transplantation-A Paired Kidney Analysis.

BACKGROUND: New-onset diabetes mellitus (NODAT) is a severe complication after kidney transplantation. It is associated with increased risk of graft failure, cardiovascular disease, mortality and infections. METHODS: We retrospectively (partially using the registry database) analyzed risk factors and clinical consequences of NODAT in patients after kidney transplantation performed at the University Transplant Centre between 2001 and 2016. To minimize the donor variability and bias, a paired kidney analysis was applied. Diabetes was defined as the need for insulin therapy for a minimum 30 days after transplantation. RESULTS: The incidence of NODAT was 7.6% (109 of 1424), but only 74 patients with NODAT had their pairs of patients without NODAT, who received kidneys from the same donor and were included to the analysis. The NODAT group was older, and with a significantly higher Charlson Comorbidity Index (2.97 vs 3.39; P = .02). The groups did not differ significantly with respect to immunosuppressive protocols and number of mismatches (2.65 vs 2.78). The incidence of acute rejection (AR; not biopsy proven) was significantly higher in the NODAT group (30% vs 13%), but the incidence of delayed graft function (DGF) was similar (40%). Creatinine concentration and estimated glomerular filration rate (using the Modified Diet in End-stage Renal Disease equation) 1-month after kidney transplantation did not differ: 1.5 vs 1.54 mg/dL and 49.3 vs 50.2 mL/min, respectively. Body mass index (BMI) was higher in the NODAT group. On multivariate analysis, factors significantly associated with NODAT were: age; AR; Charlson Comorbidity Index; and pretransplant dialysis time. BMI was higher in the NODAT group. NODAT was not a predictor of early graft loss and patient survival in the short-term analysis. CONCLUSION: AR, older age, higher comorbidity index, and BMI were risk factors for NODAT. We did not identify an influence of NODAT on early graft function and loss, but further analysis with a longer follow-up is necessary.

Ureteric Stenting in Kidney Transplant Recipients, Gdansk Centre Experience, Poland.

BACKGROUND: The role of ureteric stenting in kidney transplant recipients is still debatable. Stenting can reduce the incidence of urine leaks and ureter stenosis, but can be also associated with specific complications, particularly urinary tract infections (UTIs). MATERIAL AND METHODS: To estimate the influence of ureteric stenting on urological complications in kidney transplantation (KTx), we retrospectively analyzed all KTx performed between January 2011 and December 2016 in Gdansk Transplantation Centre, a total of 628 patients. Ureteric stenting was used in 502 patients (80%)-double-J (DJ) group. Catheters were implanted during the surgical procedure and left in situ for a mean time of 30 days. RESULT: The frequency of urinary leaks was 10 times higher in patients without stenting (10%). Ureter stenosis was also more frequent in the non-DJ group (8.7% vs 1.6%, P < .05). Multiple-regression modeling showed that the urinary not stenting was a risk factor for urinary leak (adjusted odds ratio [AOR] = 0,1; 95% confidence interval [CI]: 0.03-0.26; P < .01), ureter stenosis (AOR = 0,16; 95% CI: 0.06-0.41; P < .01), and generally reoperation after KTx (AOR = 0,46; 95% CI: 0.28-0.77; P < .01). Acute rejection and delayed graft function were equal in both groups. Mean serum creatinine concentration 1 month after transplantation was similar in both groups (1.5 mg/dL in the DJ group and 1.44 mg/dL in the non-DJ group, P > .05). UTIs were more frequent in the DJ group (22.1% vs 16.7%), but the difference was not significant. Time of hospitalization was longer in patients with UTI (34 vs 22 days, P < .05). CONCLUSIONS: Ureteric stenting can protect patients from most frequent urological complications like urine leaks and ureter stenosis. The influence of ureteric stenting on UTI development is not strong in our material.

Paired Analysis of Outcomes After Kidney Transplantation in Peritoneal and Hemodialysis Patients.

BACKGROUND: The impact of dialysis modality before kidney transplantation (hemodialysis or peritoneal dialysis) on outcomes is not clear. In this study we retrospectively analyzed the impact of dialysis modality on posttransplant follow-up. METHODS: To minimize donor bias, a paired kidney analysis was applied. One hundred thirty-three pairs of peritoneal dialysis (PD) and hemodialysis (HD) patients were transplanted at our center between 1994 and 2016. Those who received kidneys from the same donor were included in the study. HD patients were significantly older (44 vs 48 years), but the Charlson Comorbidity Index was similar (3.12 vs 3.46) in both groups. The groups did not differ significantly with respect to immunosuppressive protocols and number of mismatches (2.96 vs 2.95). RESULTS: One-year patient (98% vs 96%) and graft (90% vs 93%) survival was similar in the PD and HD patient groups. The Kaplan-Meier curves of the patients and graft survival did not differ significantly. Delayed graft function (DGF) and acute rejection (AR) occurred significantly more often in the HD recipients. Graft vessel thrombosis resulting in graft loss occurred in 9 PD (6.7%) and 4 HD (3%) patients (P > .05). Serum creatinine concentration and estimated glomerular filtration rate (using the Modification of Diet in Renal Disease guidelines) showed no difference at 1 month, 1 year, and at final visit. On multivariate analysis, factors significantly associated with graft loss were graft vessel thrombosis, DGF, and graft function 1 month after transplantation. On univariate analysis, age, coronary heart disease, and graft loss were associated with death. Among these factors, only coronary heart disease (model 1) and graft loss were significant predictors of death on multivariate analysis. CONCLUSION: The long-term outcome for renal transplantation is similar in patients with PD and HD. These groups differ in some aspects, however, such as susceptibility to vascular thrombosis in PD patients, and to DGF and AR in HD patients.

Assessment of usefulness exhibited by different tacks in laparoscopic ventral hernia repair.

BACKGROUND: Laparoscopic ventral hernia repair is becoming a popular technique with good results and fast postoperative recovery. The mesh is placed directly under the peritoneum and anchored with transabdominal sutures and tacks. However, the ideal size of the mesh covering the hernia orifice is know, nor the ideal type or amount of tacks has to be described. METHODS: To assess the forces acting on a single tack, a mathematical model of the ventral hernia was created. The force was described in reference to the surface of the hernia orifice and the pressure in the abdominal cavity. The following different types of mesh were examined in vitro: Proceed (knitted mesh), Dual Mesh (expanded polytetrafluoroethylene [ePTFE] flat mesh), and Shelhigh (biologic flat mesh). The following different tacks also were examined: Protac, Anchor, and EMS. A pig model was used to measure the forces needed to destroy the connection between mesh and tissue and to describe the place of destruction (mesh, tissue, or tack) and the force needed. RESULTS: The force acting on a single tack proportionally depends on the surface of the hernia orifice and the pressure in the abdominal cavity. The force needed to disconnect the tissue and mesh reached 8.97 +/- 0.11 N for ProTac, 2.67 +/- 0.22 N for Anchor, and 6.67 +/- 1.32 N for EMS. These values do not allow the mesh to be held in the right position when the orifice exceeds 10 cm for Protac and EMS. The disconnection of the EMS and Protac junction damages the tissue. Anchor tacks are insufficient to hold the mesh and stay in the tissue CONCLUSIONS: In the case of small hernias (diameter<10 cm) EMS or ProTac used alone are not enough to hold the mesh. Anchor is not recommended alone in any hernia.

Are mesh anchoring sutures necessary in ventral hernioplasty? Multicenter study.

BACKGROUND: Avoiding mesh fixation to the surrounding tissue in ventral hernioplasty would simplify the operation, decrease the time of the procedure, and decrease the risk of suture-related complications. METHODS: Four hospitals included 111 patients according to the common protocol for prospective clinical evaluation of sutureless ventral hernioplasty. Surgical technique involves placement of the polypropylene mesh with flat-shape memory in either the retromuscular or preperitoneal space without suture anchoring. RESULTS: Local complication rate was low (12.6%, 14 patients), postoperative pain measured according to the visual analogue scale was minimal (mean 4, range 1-8). Three recurrences (3%) were recorded. Mild scar discomfort, which did not require treatment nor limit physical activity, was recorded in 28 (25%), 18 (17%), and 11 (14%) patients at 6-month, 1- and 2-year follow-up, respectively. CONCLUSIONS: Results of the study suggest that the sutureless sublay technique is safe and effective in the treatment of ventral abdominal hernia, especially in small and medium defects.

Renal transplantation in dialysis patients with the history of coronary artery bypass grafting and cardiac valve replacement.

Death with a functioning kidney is the most frequent cause of graft failure. Cardiovascular disease is the most frequent cause of death after renal transplantation. Therefore, prior to grafting, it is mandatory to diagnose and treat coronary artery disease and heart valve impairment. Transplantation is the best option for renal replacement therapy as far as the quality of life and life expectancy are concerned, although patients with such comorbidities may experience a higher short-term mortality risk. The objective for this study was to analyze both short- and long-term results of patients after coronary artery bypass grafting (CABG) or cardiac valve replacement (CVR). The cardiac surgery recipient group (CSR) included 16 patients (15 men, 1 woman) aged from 44 to 73 (mean 54.9 +/- 7.8) years. CABG was performed in 13/16 patients, and CVR in 3/16. The rest of our patients were treated as a comparative noncardiac surgery recipient (non-CSR) group. It consisted of 422 patients (264 men, 158 women) aged from 14 to 68 years (mean 43.2 +/- 12.9). The comparison revealed that graft function estimated at 1 year after transplantation was not different: serum creatinine concentrations of 1.7 +/- 0.2 and 1.6 +/- 0.5 mg/dL in CSR and non-CSR, respectively. One-year patient survival in the CVR group of 93.8% was slightly worse than that in the non-CSR group (97.9%), but death-censored 1-year graft survivals were comparable in both groups (93.8% vs 92%). Urinary tract and cytomegalovirus infections were the most common complications in the CSR group. One patient lost his graft in month 3(rd) due to many serious infectious complications. One patient died at the end of 12 months as a result of a cardiovascular event (1/16). Our single-center results confirm that transplantation in patients after CABG or CVR is a safe procedure; therefore, such patients should be referred into the waiting list.

Is there a need for a mesh plug in inguinal hernia repair? Randomized, prospective study of the use of Hertra 1 mesh compared to PerFix Plug.

Although the mesh plug procedure is an effective operation, sutureless implantation of a single onlay mesh, if successful, would avoid the risks of plug-related complications. One hundred patients with primary inguinal hernias were randomized to undergo PerFix Plug or Hertra 1 implantation. Mean duration of the operation was similar, 38 versus 35 min for plug and onlay mesh implantation, respectively (nonsignificant, NS). The level of postoperative pain and early complication rate was similarly low in both groups (NS). Recurrence rate was the same-2 patients in each group (4%)-all following large hernia repair. The level of long-term discomfort was low after each type of operation (NS). Implantation of the onlay mesh-Hertra 1 as compared to the use of PerFix Plug is simple, safe, and equally effective in small and medium inguinal hernia repair, suggesting that a plug device is not necessary for successful hernia surgery.

A single center experience in preemptive kidney transplantation.

Transplantation is recognized as preemptive if it takes place before the initiation of chronic dialysis. This maneuver has the potential to avoid the morbidity and burden of chronic dialysis. From November 2003 to April 2005, 15 (7 male, 8 female) end-stage renal failure patients of mean age 40 +/- 14.8 years received preemptive grafts from 2 living-related and 13 cadaveric donors, constituting 11.5% of all kidney transplantations performed in our center at that time. The period on the waiting list for preemptive recipients, namely, 2 weeks to 6 months (mean, 2.4 months), was significantly shorter than that of other patients (mean, 13.8 months). The mean creatinine clearance calculated from the Cockroft Gault formula and the mean plasma creatinine level in preemptive recipients before transplantation were 12.7 +/- 3.1 mL/min and 6.6 +/- 0.8 mg/dL, respectively. The donors for preemptive and non-preemptive groups of recipients did not differ significantly in respect to age, gender, and renal function. The mean number of mismatches of 3.73 and 3.25 and the mean total ischemic times of 9.53 +/- 5 and 11.2 +/- 5 hours, in preemptive and non-preemptive groups of recipients, respectively. The incidence of delayed graft function (dialysis in the first week after transplantation) was significantly lower among preemptive recipients (20% versus 42%, respectively). The groups did not differ either in respect to the occurrence of acute rejection episodes or graft and patient survivals. In preemptive patients the mean plasma creatinine levels at 3 and 12 months were 1.37 +/- 0.3 and 1.09 +/- 0.3 mg/dL, and in non-preemptive patients 1.7 +/- 0.5 and 1.4 +/- 0.4 mg/dL. In conclusion, these results are promising, confirming the notion that preemptive kidney transplantation is the optimal treatment for end-stage renal disease patients.

Management of inguinal hernia on peritoneal dialysis: an audit of current Polish practice and call for a standard.

Peritoneal dialysis is becoming more and more common as a method of treating patients at the final stage of renal failure. In the year 2002 the number of patients treated with this method in Poland amounted to 1324. Studies have demonstrated that inguinal and abdominal hernias develop more frequently in chronic renal failure patients. The percentage of patients with hernia diagnosed within the first five years of dialysis is about 10%. Continuation of dialysis with the hernia condition left untreated may result in severe complications which are the third most frequent cause of converting treatment method into hemodialysis in PD patients. Currently in Poland there is no national standard in existence as to the management of hernias, and the only British standard from 1998 does not reflect the present expertise of either surgical treatment or dialysis methods. The aim of the current questionnaire based study investigating Polish peritoneal dialysis centers was to assess the treatment when hernia had been diagnosed in the PD patient. Of 49 dialysis centers in Poland, 39 do have protocols on managing the patient before and after the operation. A considerable diversity has been found as to surgical techniques used and the ways the patients are managed in hospital. Following the need expressed by 33 dialysis centers in Poland for some standard for relevant procedures, the authors formulated principles of modern hernia treatment in PD patients. Accordingly, the main principles include: 1) consulting a surgeon collaborating with the center before qualifying for peritoneal dialysis and when hernia symptoms have manifested; 2) Tension-free methods used in a treatment of choice (recommended by PHS); 3) Application of antibiotic prophylaxis (preferably first generation cephalosporin); 4) Induction of local or epidural anesthesia; 5) Peritoneal dialysis programme does not need to be discontinued but low volume dwells or preferably intermittent APD is recommended immediately after surgery.

Does the septic shock interfere experimental acute pancreatitis in rats?

INTRODUCTION: Acute pancreatitis is a disease involving pro-inflammatory mediators. Two complex and multifactorial pathogenetic ways lead to edematous or necrotizing pancreatitis. The course of the disease is thought to be the consequence of an acute inflammatory response. AIM: The authors examined the impact of Escherichia coli LPS on the acute cerulein pancreatitis in rats. METHODS: The study was performed on rats using the ceruleine pancreatitis model. The activation status of polymorphonuclear cells, blood IL-6 concentration, oxidative stress parameters, pancreatic enzymes concentration and microscopic alterations were determined at 5th and 9th h observations. RESULTS: In acute pancreatitis and acute pancreatitis with LPS groups, the peripheral polymorphonuclear cells activity was lower than in control one. Authors noticed the same neutrophil activation in acute pancreatitis after lipopolysaccharide administration although the peripheral blood polymorphonuclear cells count was significantly higher at the 9th h observation. LPS neither changed the oxidative stress within pancreatic gland, nor amylase or serum lipase activity. LPS given to acute pancreatitis animals resulted in significant increase of serum IL-6 concentration at 5th observation turning normal after 9th h. CONCLUSIONS: Collected data supports thesis of early polymorphonuclear cells involvement in acute pancreatitis and oxidative stress evidence in pancreatic parenchyma. However, results did not reveal that administration of LPS amplified inflammatory response during the course of acute pancreatitis.

Psychological Well-Being in Patients After Preemptive Kidney Transplantation.

BACKGROUND: Preemptive kidney transplantation (PKT) is associated with improved patient and graft survival as compared with transplantation in previously dialyzed patients. Complications related to dialysis are avoided in preemptively transplanted patients. Psychological functioning of those patients is still under investigation. The aim of the study was to evaluate the acceptance of illness, satisfaction of life, and anxiety in patients preemptively transplanted (PET) and transplanted after dialysis (PTD). METHODS: The present study compares 23 pairs of PET and PTD patients after kidney transplantation from the same donor. Each patient completed a set of psychological questionnaires: Acceptance of Illness Scale, Satisfaction With Life Scale, and State-Trait Anxiety Inventory. Pairs were examined in the same moment, from 7 days to 5 years after transplantation. The PET and PTD groups did not differ significantly in respect to sex, underlying renal diseases, incidence of acute rejection, surgical complications, and graft function. More PTD patients had delayed graft function (P < .05). RESULTS: The statistical analysis revealed a significant lower acceptance of illness as well as satisfaction with life in PET recipients (P < .05). The groups differed significantly in the trait of anxiety but not in the state of anxiety. CONCLUSIONS: Although the medical benefits of PKT are widely known, numerous psychological problems may occur in patients who do not have difficulties of dialysis and who after transplantation are faced with unexpected discomfort, which influences psychological well-being. Further effort should focus on providing psychological support during qualification to the transplantation and in follow-up after surgery.

Treatment of the Lymphocele After Kidney Transplantation: A Single-center Experience.

BACKGROUND: Lymphocele is one of the most common complications after kidney transplantation. It is usually asymptomatic, but can cause pressure on the kidney transplant, ureter, bladder, and adjacent vessels with deterioration of graft function, ipsilateral leg edema, and external iliac vein thrombosis. Peritoneal fenestration is a well-established method for treatment. In this report, we present the incidence of symptomatic lymphocele requiring treatment (LRT), demographic and surgical factors that influenced lymphocele formation, its clinical presentation, and 2 types of treatment: open and laparoscopic intraperitoneal drainage in the experience of our center. MATERIAL AND METHODS: We retrospectively analyzed all kidney transplantations performed between January 2007 and December 2014 in Gdansk Transplantation Center (n = 740) and selected patients with LRT. LRT occurred in 59 cases (8%). All other patients transplanted during the same time (n = 681) were treated as a control group in the univariate and multivariate analysis of risk factors of the lymphocele formation. RESULTS: Surgical intraperitoneal drainage was performed in an open method in 53 cases and laparoscopically in 6 patients. We observed recurrence of lymphocele in 11 cases (18.6%). Acute rejection episodes (ARE) and delayed graft function (DGF) were more frequent in patients with LRT. ARE and age were independent risk factors for LRT in multivariate analysis. The mean estimated glomerular filtration rate by the Modification of Diet in Renal Disease method at 1 month after the fenestration was higher than before the operation (51.7 and 43.6 mL/min, respectively). CONCLUSIONS: Fenestration is a safe and effective method of treatment of symptomatic lymphocele. ARE, DGF, and older age were associated with a greater risk of LRT.

Quality of Life After Kidney Transplantation: A Prospective Study.

BACKGROUND: The purpose of renal transplantation is to achieve a maximal improvement in quality of life (QoL) and life expectancy in patients with end-stage renal disease (ESRD) while minimizing the potential side effects of this procedure. It is important to achieve an optimal balance between graft function and the patient's QoL. This study was designed to assess the changes in the QoL after kidney transplantation (KTx) in patients with ESRD previously treated with hemodialysis (HD) or peritoneal dialysis (PD). METHODS: QoL was prospectively analyzed in 69 patients after kidney transplantation in a single-center study. Patients with ESRD were divided into 2 groups: those previously treated with HD (n = 44 patients; group 1) or PD (n = 25 patients; group 2). Both groups were asked to complete the KDQOL-SFtm questionnaire before and 12 months after kidney transplantation. RESULTS: We observed significant differences in many parameters of QoL in both groups after KTx but more positive changes of most parameters in question exhibited by patients previously treated by means of HD than PD. Patients treated with HD and PD demonstrated improvement after KTx in 74% of dimensions. There were no statistical differences in the QoL between group 1 and group 2 before or after KTx. CONCLUSIONS: The study demonstrated post- to pre-transplant improvements of QoL independently of previous treatment.